Building the Provider Pipeline for Primary Care

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Are you sick? Or are you just sick of hearing about healthcare reform? Clearly, healthcare reform has been a key part of our national conversation for many years. We are making great progress, but there is still a long, long way to go.

If you are indeed medically sick and need to be seen by a healthcare professional, typically you would call your primary care providers office, make an appointment, and you're all set for your visit. A simple process, which many of us take for granted.

The reality for many Americans is not so easy. Because of limited access to primary care providers, today 20 percent, or more than 75 million, Americans go to emergency departments to receive care which they could have gotten from a primary care provider. This is more expensive, far less efficient, and, possibly, not as safe as simply having access to primary care.

Primary care providers orchestrate and direct care, and help patients navigate choices in their care. Enabling primary care providers and increasing our national primary care capacity is the most cost-effective and clinically sensible solution for our troubled national health system.

But, by 2025, there will be a shortage between 12,500 and 31,000 primary care physicians. And rural areas are hit exceptionally hard: for every 100,000 people, there are only 68 primary care physicians. If you have no primary care doctor within 100 miles of your home, and no car to get there, you don't really have access to healthcare.

This is a tremendous problem we're facing. So why the shortage?

Fifty years ago, half of the doctors in America practiced primary care, but today fewer than one in three of them do. Also, today, fewer medical trainees are choosing to enter primary care. Only one out of every four or five medical students have chosen primary care careers in the past 10 years. Twenty years ago, nearly half chose primary care. The lure of specialty medicine, large primary care patient loads, anticipated or desired lifestyle, and school debt concerns are just some of the reasons students are opting out of primary care. But it is also an institutional challenge. Of the 750+ hospitals with residency programs, more than 150 graduated no one in primary care at all. And while the Physician Assistant (PA) profession was stimulated in part by the need to increase access to primary care, fewer than 50 percent of PAs are practicing primary care.

But the general lack of primary care providers alone isn't the only issue we're facing.

One special consideration is that primary care is built on relationships - particularly in underserved, ethnically diverse communities. Patients often prefer to see providers to whom they can relate to culturally to help facilitate trust quickly. This trust and connection is known to improve care and can change lives indefinitely. To be culturally competent, particularly from the vantage point of the patient, providers must understand how financial, social and cultural factors affect one's health and attitudes about illness or disability. Further, it is critical to know how cultural perspective changes how one might access services or comply with prescribed treatments.

In the United States, African Americans, Latino and Hispanic Americans and Native Americans currently makeup 25 percent of the adult population, but only represent six percent of physicians. The nation's changing demographics and healthcare needs clearly illustrate the need for a more diverse healthcare workforce. The U.S. is projected to be even more diverse in the coming decades. By 2055, the U.S. will not have a single racial or ethnic majority.

One program is making a difference and should be scaled to have even broader impact. With support from the GE Foundation, National Medical Fellowships is the leading Primary Care Leadership Program that provides first-hand experiences for medical and nursing students to encourage students with diverse backgrounds to pursue careers in primary care. Since launching the program in 2012, more than 300 diverse scholars have participated in the program which now has grown to 11 cities, across 10 states. In 2016 alone, 93 percent of our scholars are ethnically diverse I'm proud to report, that since inception, 83 percent of the students who have graduated have selected to stay in primary care.

This program is committed to building the provider pipeline for primary care, and to ensure that pipeline is diverse and represents the nation's ever-changing demographics. This program and others like it are a key component in ensuring that our changing health care system under the umbrella of rapid and dramatic reformation is successful at providing access to excellent and culturally competent care. It is necessary for impactful reform.

To learn more about the National Medical Fellowships Primary Care Leadership Program, click here.